You confide in your closest friend about so many things -- career stress, worries about your child’s grades, and an argument with your husband. But if you’re like most women, there’s one thing you would never admit to her, or to anyone else -- bladder control issues. Your problem is that lately, you have to run to the bathroom more and more -- and you don’t always make it.

One out of every four women over the age of 18 experiences episodes of leaking urine involuntarily, but most of them aren’t talking about it.

Reluctance to admit to overactive bladder or continence issues affects women in all age groups. “The woman who’s just delivered a child and finds she isn’t getting bladder control back -- she runs to pick up her copy of What to Expect When You’re Expecting, and this isn’t there," says Linda Brubaker, MD, professor in the Department of Obstetrics & Gynecology and Urology at Loyola University Chicago Stritch School of Medicine and director of the Division of Female Pelvic Medicine and Reconstructive Surgery at Loyola University Health System (LUHS).

"A woman who’s growing older sees men on television talking about erectile dysfunction -- but not women sharing their stories about continence,” she adds.

OAB: Emotional Challenges

On average, women wait more than six years from the time they first have bladder problems until they get a diagnosis, and during that time, they face a lot of emotional challenges.

“Especially as overactive bladder and other continence problems become more severe, it can be very distressing, embarrassing, and ultimately isolating,” says Ross Rames, MD, associate professor of urology at the Medical University of South Carolina, who works with MUSC’s multidisciplinary Bladder and Pelvic Health Center.

As people lose control over their bladders, they tend to withdraw socially. That means missing out on things they enjoy in life, which could be anything from regular church attendance to movies, ball games, and concerts. “They won’t go to events because they can’t sit through them without rushing out multiple times to go to the bathroom,” Rames says.

Restricting yourself that way can have an impact on your physical health as well. “Women may stop going for walks because they’re afraid to be that far from the bathroom,” says Brubaker. “Or they may stop playing sports -- even ‘grandma soccer’ with the kids -- because they’re afraid of leakage accidents. So their lives become more sedentary.”

OAB can also cause problems at work. “Imagine if you’re a schoolteacher and you have to stand up in front of a classroom of fourth-graders for an hour or more without a break,” Rames says. What if you're an executive who has to make a long presentation to colleagues -- or a physician who can’t just rush out to the bathroom in the middle of surgery? In so many ways, OAB can make it difficult to do your job due to the emotional stress caused by worrying about sudden, strong urges to go.

OAB, Sleep, and Depression

Most people will agree that getting a good night of sleep can make a big difference in the day that follows. When OAB disrupts sleep, it can leave you feeling groggy from all the interruptions caused by trips to the bathroom and it can affect your overall feeling of well-being.

According to research on women with OAB by the National Association for Continence (NAFC), sleep disruption can affect a woman's sense of "normalcy" during daytime hours. Half of the women in a series of online interviews reported that their OAB includes a condition called nocturia, which is marked by multiple overnight bathroom visits. Women who made two or more nighttime bathroom trips were more likely to report they experienced depression than women who said they have OAB without nocturia.

Overactive Bladder and Sex

OAB and other bladder problems can also cause trauma in the bedroom. “There may be discomfort, or overactive bladder and urine loss during intercourse, as well,” Rames says. “That gets in the way of intimate relationships.” It can also leave you feeling unattractive and undesirable.

There’s no rest from the emotional impact of incontinence at night, either. Many women with OAB and other continence issues have what’s called “nocturia,” meaning that they need to get up to use the bathroom at least twice every night -- and sometimes, much more often than that. Constant sleep interruptions can take their toll, leaving you exhausted overwhelmed.

“Even if you don’t have a bladder problem it’s normal to get up at least once a night to empty a full bladder,” Brubaker says. “If all’s going well, you wake up, go to the bathroom, go back to bed, and fall back to sleep. But the more you have to wake up, the more your sleep patterns get disturbed. And a number of people report that they begin to leak on the way to the bathroom at night, which is even more stressful and can put you at risk for falls.”

Managing OAB Day to Day

What can be particularly frustrating is that even once you’ve found a doctor and begun treatment for OAB symptoms, they’re probably not going to go away overnight -- nor is there a one-size-fits-all treatment.

“Most people have ‘mixed’ incontinence, meaning that they may have symptoms of both stress incontinence and urge incontinence, or overactive bladder as well,” says Brubaker. “We don’t have a single treatment that works on everything, so if you’ve got multiple symptoms from each condition, it’s likely that you’ll have to have more than one type of treatment.”

She advises women (and men) in treatment for OAB to think of their condition as a lifelong, chronic, but manageable problem rather than something that can be treated and permanently cured. “If you developed diabetes at 40, you wouldn’t take a medication and expect that you wouldn’t have it anymore at 50. It’s a lifetime condition. You’re going to start treatment, but as you age, it will remain a challenge and may get worse,” Brubaker says. “It’s the same with incontinence.”

Unfortunately, the continuing stigma surrounding OAB means that there aren’t a lot of sources of support out there for those who struggle with the embarrassment, isolation, career challenges, depression, anxiety, frustration and sleep deprivation produced by an uncooperative bladder.

While you’re getting emotional support, Brubaker says to make sure that you’re getting medical support as well. “If you feel your life closing in around you, see a doctor. There are lots of options. You shouldn’t have to be planning your life around your bladder -- your bladder should be keeping up with you.”